Implementing Medicare Payment Changes

Health & Human Services (HHS)

The Challenge

In April 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to change the way Medicare pays doctors and other clinicians in order to reward value of care over quantity of care. Until MACRA is implemented, providers and their staff have to navigate a network of Centers for Medicare & Medicaid Services (CMS) systems that are disjointed, complicated, and rarely synchronized. Doctors already have incentives for better performance, but have trouble understanding scoring rules across multiple programs or feedback on their specific performance, which is given to them in lengthy PDFs.

The Solution

Implementing the MACRA legislation required significant changes to how Medicare measures the value of care doctors provide. CMS engaged USDS to bring best practices and modern approaches to ensure the implementation of the transition was clear and effective. Since launching a plain language website in October 2016, USDS has continued to work with CMS to improve the Quality Payment Program (QPP) by supporting technical decision-making and encouraging customer-driven development processes.

Update

In April 2017, USDS supported the launch of an online tool on qpp.cms.gov that reconciles data from many disparate data systems and leverages user-centered design principles. The tool helps doctors enter a well-known identifying number (their National Provider Identifier) and immediately see and easily understand their reporting requirements for the program. This will be an important starting point in helping doctors understand how to interact with the program in 2018.

The QPP website allows doctors and clinicians to instantly check their program eligibility, then easily identify their reporting requirements.

Working with CMS, USDS has also implemented an Application Programming Interface (API) strategy to reduce the cost and burden of participating in CMS programs by enabling the market to build software that interacts directly with Medicare systems and data. The first API released for QPP made quality measures data open source and led the private sector to develop new tools—including an iPhone app to look up QPP measures—within a week of going live.

USDS is collaborating with the market to develop APIs for QPP to replace manual submission processes, provide real-time feedback and scoring, and create a platform for building QPP-related solutions. A public beta version is in use by more than 20 tech firms. The QPP team made a production version available at the end of 2017 that will reduce the reporting burden for health IT partners, clinicians, and groups in 2018.

Finally, USDS worked with CMS to award an agile Blanket Purchase Agreement (BPA) for small agile companies to support QPP development efforts. Unlike traditional procurements, many task orders in this BPA require working software prototypes as part of the competitive process.